Recent Publications
The long-term health effects of welfare reform
By Emily C. Dore, Rita Hamad, Kelli A. Komro, Melvin D. Livingston, III
Childhood poverty is associated with poor health in adulthood, but social policies may buffer poverty's long-term harmful effects by providing cash and in-kind resources. This study assessed the long-term health effects of welfare reform, which added work requirements, sanctions for noncompliance, lifetime limits, and family caps to welfare programming in the US in the mid-1990s. Research has found mixed evidence on the short-term health effects of welfare reform, but fewer studies have documented its impacts on health across the life course. This study exploited temporal and state variation in the implementation of welfare reform to examine the association between exposure to welfare reform as a child on self-rated health, psychological distress, and chronic conditions in adulthood using data from the Panel Study of Income Dynamics. We found that welfare reform exposure in early childhood, from conception to age five, was associated with more psychological distress (b = 0.41, 95%CI 0.08, 0.74) and more chronic conditions (b = 0.21, 95%CI 0.10, 0.33) in adulthood. We also found that welfare reform exposure in later childhood, from ages six to 18, was associated with lower likelihood of reporting poor health (b = −0.03, 95%CI -0.05, −0.01), less psychological distress (b = −0.33, 95%CI -0.54, −0.11), and fewer chronic conditions (b = −0.18, 95%CI -0.25, −0.10), which was especially true for non-Hispanic Black and Hispanic individuals compared to non-Hispanic White individuals. Our findings suggest that the difference in outcomes based on age of exposure is related to the ease with which parents fulfill welfare requirements, though more research is needed on possible mechanisms.
Geographical variation in the long-arm of childhood
By Emily C. Dore
Scholars have documented the lasting impact of childhood socioeconomic status (SES) on health, but few studies have considered how state contexts in childhood shape health trajectories based on childhood SES across the life course. The current project uses data from the Panel Study of Income Dynamics, 2009–2021 (N = 18,227 person-year observations of adults aged 18–41) to build on these studies by 1) examining state variation in the relationship between childhood SES and adult self-rated health, and 2) assessing the contributions of childhood state-level economic context in moderating this relationship. Logistic regression models first confirmed the expected relationship between childhood SES and adult self-rated health that parallels other literature (OR = 1.79, 95% CI 1.46, 2.19). Of the 37 states included in the analysis, there was a statistically significant difference in reporting poor health between low and high-childhood SES groups in 14 states. The interaction between childhood SES and state-level income inequality (OR = .01, 95% CI -9.77, −.62), suggests that exposure to higher levels of income inequality in childhood was more harmful for the health of individuals from higher SES backgrounds. The interaction between childhood SES and unemployment rates (OR = 1.13, 95% CI 1.03, 1.24), suggests that exposure to higher unemployment rates in childhood was more harmful for the health of individuals from lower SES backgrounds. This study finds important state-variation in the relationship between childhood SES and adult health and identifies income inequality and unemployment rates as factors in these differences.
Self-rated health predicts mortality — but it depends on your age
By Emily C. Dore and Ellen Idler
While self-rated health (SRH) has long been known to predict mortality in adult populations, the age of respondents plays an interesting and complex role in both explaining and modifying the association. The objective of this study is to test for differences by age in the association of SRH with all-cause mortality. Because much of the research has been conducted with older samples, a wider age range of adults may show that some age groups have more predictive SRH than others. We estimated Cox proportional hazards models to determine if SRH in 1999 predicted survival to 2021 differently based on age, using data from the Panel Study of Income Dynamics. The sample consisted of 5843 respondents aged 25 to 97 who were interviewed in 1999 and followed for survival until 2021. We included demographic and socioeconomic factors, physical health and mental health indicators, and health risk behaviors as covariates to assess their potential mediating role in the predictive ability of SRH. The results showed a significant interaction between SRH and age, with larger and more significant hazards for those aged 40–54 and 55–74. There were no significant effects at all for the youngest group and virtually none for the oldest group. For example, for individuals aged 40–54, there were significant HRs for poor health (2.49, 95% CI 1.05, 5.89) and fair health (1.95, 95% CI 1.11, 3.42) compared to excellent health in the fully adjusted models. Our findings suggest that age group differences in the predictiveness of SRH may reflect an absence of health knowledge and experience for younger respondents, and a survivor bias for the oldest age group due to the lifetime elimination of those with poor health.
The long-term health effects of childhood exposure to social and economic policies
By Emily C. Dore and Jordan Wurapa
While numerous studies have found a relationship between social and economic policies and short-term health outcomes, fewer studies have explored the long-term health effects of these policies. Given the important association between childhood circumstances and health in adulthood, long-term population health consequences should be considered when designing social and economic policies. This review summarizes the existing literature on the long-term effects of childhood exposure to social and economic policies on adult health, summarizes the findings, the methods employed, and indicates areas for future research. The review process followed the JBI scoping review protocol and PRISMA-ScR reporting guidelines. The search was conducted in three electronic databases (Web of Science, Pub Med, and SCOPUS), and focused on peer-reviewed manuscripts that studied the effects of policy exposures during childhood on health in adulthood. A total of 3471 articles were collected from the databases and 18 were identified as meeting the eligibility criteria. The most commonly studied policies were safety-net policies (N = 6), followed by education policies (N = 5), civil rights policies (N = 3), government investments (N = 3), and child labor laws (N = 1). The health outcomes varied and included chronic conditions, mental health, mortality, and self-rated health. The studies also overwhelmingly employed causal inference techniques (N = 13), including difference-in-differences study designs and instrumental variable analysis. Most studies found long-term positive effects of policies that provided extra resources to historically under-resourced populations, or policies that aimed to increase equality of opportunity. However, there were some studies with null or mixed findings, especially when examining the long-term health effects of education reform. More literature is needed on this important topic, and now is the time to capitalize on longer follow-up periods in currently available data.
Structural sexism and preventive health care use in the United States
By Emily C. Dore, Surbhi Shrivastava, and Patricia Homan
Preventive health care use can reduce the risk of disease, disability, and death. Thus, it is critical to understand factors that shape preventive care use. A growing body of research identifies structural sexism as a driver of population health, but it remains unknown if structural sexism is linked to preventive care use and, if so, whether the relationship differs for women and men. Gender performance and gendered power and resource allocation perspectives lead to competing hypotheses regarding these questions. This study explores the relationship between structural sexism and preventive care in gender-stratified, multilevel models that combine data from the Behavioral Risk Factor Surveillance System with state-level data (N = 425,454). We find that in states with more structural sexism, both men and women were less likely to seek preventive care. These findings support the gender performance hypothesis for men and the gendered power and resource allocation hypothesis for men and women.
Easing cash assistance rules during COVID-19 was associated with reduced days of poor physical and mental health
By Emily C. Dore, Melvin D. Livingston, and Paul R. Shafer
Unemployment rates soared at the beginning of the COVID-19 pandemic in the US, increasing financial stress that can affect physical and mental health. Temporary Assistance for Needy Families (TANF) is the primary cash assistance program for low-income families in the US, with benefits conditional on work activities and subject to suspension. However, many states loosened requirements during the pandemic. Using TANF policy data and data from the Behavioral Risk Factor Surveillance System from the period January 2017–December 2020 with a triple difference design, we found a general protective effect of supportive changes to TANF on poor physical and mental health days and binge drinking during the COVID-19 pandemic for likely TANF participants. For example, providing emergency cash benefits to those not already participating in TANF, waiving work requirements, waiving or pausing sanctions, and automatically recertifying benefits were associated with reductions in the number of mentally unhealthy days. This study provides support for increasing generosity and easing administrative burdens in safety-net programs to buffer against negative impacts of public health and economic crises.
State-level data on TANF policy changes during the COVID-19 pandemic
By Emily C. Dore, Paul R. Shafer, and Melvin D. Livingston, III
Objective COVID-19 mitigation measures prompted many states to revise the administration of their welfare programs. States adopted policies that varied across the U.S. to respond to the difficulties in fulfilling program requirements, as well as increased financial need. This dataset captures the changes made to Temporary Assistance for Needy Families (TANF) programs during the COVID-19 pandemic, from March 2020 through December 2020. The authors created this dataset as part of a larger study that examined the health effects of TANF policy changes during the COVID-19 pandemic.
Data description TANF is the main cash assistance program for low-income families in the U.S., but benefits are often conditional on work requirements and can be revoked if an individual is deemed noncompliant. Structural factors during the COVID-19 pandemic made meeting these criteria more difficult, so some states relaxed their rules and increased their benefits. This dataset captures 24 types of policies that state TANF programs enacted, which of the states enacted each of them, when the policies went into effect, and when applicable, when the policies ended.